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Heart Rhythm. 2010 Nov;7(11):1537-42. doi: 10.1016/j.hrthm.2010.07.018. Epub 2010 Jul 19.

Ethical and legal views of physicians regarding deactivation of cardiac implantable electrical devices: a quantitative assessment.

Author information

1
CardioVascular Institute, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02446, USA. dkramer@bidmc.harvard.edu

Abstract

BACKGROUND:

Despite the high prevalence of pacemakers and implantable cardioverter-defibrillators, little is known about physicians' views surrounding the ethical and legal aspects of managing these devices at the end of life.

OBJECTIVE:

The purpose of this study was to identify physicians' experiences and views surrounding the ethical and legal aspects of managing cardiac devices at the end of life.

METHODS:

Survey questions were administered to internal medicine physicians and subspecialists at a tertiary care center. Physicians were surveyed about their clinical experience, legal knowledge, and ethical beliefs relating to the withdrawal of PM and ICD therapy in comparison to other life-sustaining therapies.

RESULTS:

Responses were obtained from 185 physicians. Compared to withdrawal of PMs and ICDs, physicians more often reported having participated in the withdrawal or removal of mechanical ventilation (86.1% vs 33.9%, P <.0001), dialysis (60.6% vs 33.9%, P <.001), and feeding tubes (73.8% vs 33.9%, P <.0001). Physicians were consistently less comfortable discussing cessation of PMs and ICDs compared to other life-sustaining therapies (P <.005). Only 65% of physicians correctly identified the legal status of euthanasia in the United States, and 20% accurately reported the legal status of physician-assisted suicide in the United States. Compared to deactivation of an ICD, physicians more often characterized deactivation of a PM in a pacemaker-dependent patient as physician-assisted suicide (19% vs 10%, P = .027) or euthanasia (9% vs 1%, P <.001).

CONCLUSION:

In this single-center study, internists were less comfortable discussing cessation of PM and ICD therapy compared to other life-sustaining therapies and lacked experience with this practice. Education regarding the legal and ethical parameters of device deactivation is needed.

PMID:
20650332
PMCID:
PMC3001282
DOI:
10.1016/j.hrthm.2010.07.018
[Indexed for MEDLINE]
Free PMC Article

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